What is BPPV? Benign Paroxysmal Positional Vertigo

Its benign, so we know it will clear up and it’s nothing to worry about in the long term. It’s influenced by position/posture, and it comes on suddenly (and usually clears up rapidly).

What’s it like?

Seemingly out of nowhere, your head is swimming and you feel as though you may fall over at any moment.

Each story is different but classically patients describe a sudden onset of dizziness, the room seems to be swimming, they feel like they’re on a carousel and can’t get off, they may say that they feel the ground is floating, they often say they need to keep the head still and on waking in the morning they will be reluctant to lift the head from the pillow for fear of experiencing the dizziness.

Do I need to see a doctor?

Dizziness can be the sign of something more serious going on and that’s why it’s important to check first with your doctor. But BPPV is the most straightforward glitch that leads to dizziness. It’s a mechanical problem and that’s why physiotherapists treat it. The dizziness it provokes can be very distressing and severe but it is the most straightforward to correct and it responds well to treatment.

What’s happening with BPPV?


These tiny crystals roll around inside the semi-circular canal (the utricle). They move when you move and their movement stimulates your sensory system. The information gets processed in your brain resulting in you feeling balanced. Rarely these tiny crystals, (the otoconia) can get dislodged and roll into the wrong part of the semi-circular canals. Immediately the wrong information is going into the system and the central processing is all muddled. So you feel all at sea.

In order to restore the system we have to get the crystals back where they should be; once they are in the right location, normal service can be resumed.

Try this quick test to see how your balance is:

Stand up straight with your feet hip width apart and close your eyes. Do you feel steady? Keep your eyes closed, do you feel as though you’re swaying? Can you balance on one leg only with your eyes open? What about with your eyes closed?

Several systems come into play in order to help us keep our balance, the semi-circular canals, the eyes, the hearing and the central processor is the brain of course.

Labyrinthitis is a slightly different situation, this is inflammation within the labyrinth – the innermost part of the ear and it usually follows a cold or flu. All of the sensory systems are disrupted and this time they recover more slowly.

Physiotherapists treat patients with labyrinthitis but this time the treatment involves particular exercises performed by the patient, regularly at home. The exercises gradually re-train the sensory system alongside the central processing that together make you feel balanced.

There’s  an NHS video, Hazel’s Story, on YouTube which illustrates this very well.

At Richmond Physiotherapy we have several physiotherapists qualified in vestibular rehabilitation and in November we are running a CPD course for physiotherapists with Amanda Male.

We know how to test safely for BPPV and how to treat it effectively. We also offer vestibular rehabilitation via GP or consultant referrals.

If you are worried that the dizziness you have could be related to some other cause, rest assured we will refer you to the appropriate specialist consultants if necessary.

For any queries give us a call and we will be happy to discuss.


Lawton Gate House,
7 Hill Street, Richmond,
London, TW9 1SX

020 8332 1132